Thumb Surgery Can Offer Relief for Arthritis Pain

Thumb arthritis surgery is an option when arthritis is causing debilitating pain and stiffness that doesn’t respond to alternative treatments.

Thumb arthritis is a painful condition of joint inflammation typically affecting the basal joint at the base of the thumb, also known as the “carpometacarpal (CMC) joint.”

Its most common cause is osteoarthritis, a type of arthritis that can cause bone-on-bone friction and lead to total joint deterioration.

While there are a number of nonsurgical treatments available to manage thumb arthritis (sometimes called “basal thumb arthritis”), surgery is an option when traditional approaches aren’t helping.

There’s no singular thumb arthritis surgery that works for everyone. When a doctor recommends surgery, a handful of options are available based on your specific needs.

Ligament reconstruction

This procedure involves stabilizing your thumb joint using a piece of the flexor tendon from your wrist. It’s used when thumb arthritis is caused by looseness in the joint but not cartilage loss.

While ligament reconstruction may help preserve the thumb joint for some time, it doesn’t repair or stop tissue damage.

Ligament reconstruction and tendon interposition (LRTI)

This surgery type is the most regularly performed for thumb arthritis surgery. LRTI involves removing the damaged tissues of the joint and replacing them with a cushion made from your flexor carpi radialis (FCR) tendon or an artificial insert.

LRTI includes the partial or complete removal of your trapezium bone to help create space and reduce bone friction.

Trapeziectomy

When tendons aren’t rearranged, and only the trapezium bone is removed, the procedure is known as a “trapeziectomy.”

A systematic review and research of more than 8 studies and 600 people found no statistical difference in the outcomes between LRTI and simple trapeziectomy.

The research also noted LRTI had more short-term postoperative risks, higher surgical costs, and more procedure-related injuries.

Hematoma and distraction arthroplasty

Hematoma and distraction arthroplasty is a controversial procedure because of the limited evidence to support its use.

The procedure involves a trapeziectomy and the placement of a wire to immobilize your thumb in an overcorrected position. The goal is to encourage scar tissue in a specific location to create an artificial joint.

Total joint replacement (arthroplasty)

When thumb arthritis has severely affected your CMC, it’s possible to completely replace the joint with a prosthetic.

Arthroplasty isn’t a first-line option, as arthroplasty may not be as durable as tendon grafts for long-term use.

A review from 2019 shows that different implants have varying rates of failure, but overall failure rates of nonimplant techniques are better than those of arthroplasty.

Arthrodesis

Arthrodesis is the process of fusing bones. A surgeon fits the bones in your thumb joint inside one another and locks them in place with a metal pin. In time, new bone growth should fuse the pieces together.

Research indicates arthrodesis is traditionally used in younger people with osteoarthritis because it can offer better stability and strength compared with other thumb arthritis surgeries.

Arthrodesis isn’t an option for everyone. The procedure is complex and comes with a risk that the bones won’t fully fuse together, resulting in the need for multiple follow-up surgeries.